NRNP 6665 MIDTERM EXAM | QUESTIONS AND
ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTIONS.
SECTION I: PSYCHIATRIC ASSESSMENT AND DIAGNOSIS
1. A 10-year-old child presents with developmentally inappropriate and
persistent difficulty with inattention, with symptoms interfering with academic
goals and in social settings. This is consistent with which diagnosis?
A) Conduct disorder
B) Autism spectrum disorder
C) Generalized anxiety disorder
D) Attention-deficit/hyperactivity disorder
Correct Answer: D
Rationale: ADHD is characterized by a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning or development.
Symptoms must be developmentally inappropriate and present in at least two
settings (e.g., home and school) .
2. Which of the following is NOT consistent with good sleep hygiene?
A) Allow child to keep a cell phone at bedside
B) Establish bedtime routines and maintain consistently
C) Limit use of electronics in the evening
D) Set and maintain a bedtime that will allow for adequate sleep
Correct Answer: A
Rationale: Good sleep hygiene includes establishing consistent bedtime routines,
limiting electronics before bed, and maintaining a regular sleep schedule. Allowing
,a cell phone at the bedside disrupts sleep and is NOT consistent with good sleep
hygiene practices .
3. A patient presents endorsing persistent low-grade (sub-acute) depression for
the last several years, uncertain of when it started, and states, "I think I have
always been depressed but still go through the motions." These symptoms are
consistent with which diagnosis?
A) Dysthymia (Persistent Depressive Disorder)
B) Cyclothymic disorder
C) Major Depressive Disorder
D) Adjustment disorder with depressed mood
Correct Answer: A
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by a
depressed mood for most of the day, for more days than not, for at least 2 years in
adults (1 year in children/adolescents). The patient's description of chronic, low-
grade depression without clear onset is consistent with this diagnosis .
4. The clinician asks a child who is being seen for labile mood: "Have you felt
really down, depressed, or uninterested in things you used to enjoy for more
than 2 weeks?" This screens for which diagnostic category?
A) Suicidality
B) Bipolar disorder
C) Major Depressive Disorder
D) Disruptive Mood Dysregulation Disorder
Correct Answer: C
Rationale: This question screens for Major Depressive Disorder (MDD). The key
criteria for a major depressive episode include depressed mood or anhedonia (loss
of interest/pleasure) lasting at least 2 weeks. While mood lability can be present in
, Bipolar Disorder, the specific inquiry about prolonged depressive symptoms aligns
most directly with MDD .
5. During the evaluation of a patient with a history of Bipolar I Disorder who is
manic, the patient states that she is actually the Queen of England and quite
wealthy. This is an example of which of the following?
A) Mood-congruent manic delusion
B) Mood-incongruent manic delusion
C) Mood-congruent manic hallucination
D) Mood-incongruent manic hallucination
Correct Answer: A
Rationale: A mood-congruent manic delusion aligns with the elevated or expansive
mood of mania. The belief of being royalty and wealthy reflects grandiosity, a
common symptom of manic episodes. Mood-incongruent delusions do not align
with the prevailing mood state and are less typical in mania .
6. A period of at least one week in which both a manic episode and a major
depressive episode occur almost daily is consistent with which diagnosis?
A) Bipolar II Disorder
B) Bipolar I Disorder, mixed episode
C) Bipolar I Disorder, cyclothymic type
D) Major Depressive Disorder with mixed features
Correct Answer: B
Rationale: A mixed episode in Bipolar I Disorder is characterized by criteria for
both a manic episode and a major depressive episode occurring nearly every day
for at least one week. This is distinguished from Bipolar II Disorder, which involves
hypomanic episodes rather than full manic episodes .
ANSWERS | 2026 UPDATE | WITH COMPLETE
SOLUTIONS.
SECTION I: PSYCHIATRIC ASSESSMENT AND DIAGNOSIS
1. A 10-year-old child presents with developmentally inappropriate and
persistent difficulty with inattention, with symptoms interfering with academic
goals and in social settings. This is consistent with which diagnosis?
A) Conduct disorder
B) Autism spectrum disorder
C) Generalized anxiety disorder
D) Attention-deficit/hyperactivity disorder
Correct Answer: D
Rationale: ADHD is characterized by a persistent pattern of inattention and/or
hyperactivity-impulsivity that interferes with functioning or development.
Symptoms must be developmentally inappropriate and present in at least two
settings (e.g., home and school) .
2. Which of the following is NOT consistent with good sleep hygiene?
A) Allow child to keep a cell phone at bedside
B) Establish bedtime routines and maintain consistently
C) Limit use of electronics in the evening
D) Set and maintain a bedtime that will allow for adequate sleep
Correct Answer: A
Rationale: Good sleep hygiene includes establishing consistent bedtime routines,
limiting electronics before bed, and maintaining a regular sleep schedule. Allowing
,a cell phone at the bedside disrupts sleep and is NOT consistent with good sleep
hygiene practices .
3. A patient presents endorsing persistent low-grade (sub-acute) depression for
the last several years, uncertain of when it started, and states, "I think I have
always been depressed but still go through the motions." These symptoms are
consistent with which diagnosis?
A) Dysthymia (Persistent Depressive Disorder)
B) Cyclothymic disorder
C) Major Depressive Disorder
D) Adjustment disorder with depressed mood
Correct Answer: A
Rationale: Persistent Depressive Disorder (Dysthymia) is characterized by a
depressed mood for most of the day, for more days than not, for at least 2 years in
adults (1 year in children/adolescents). The patient's description of chronic, low-
grade depression without clear onset is consistent with this diagnosis .
4. The clinician asks a child who is being seen for labile mood: "Have you felt
really down, depressed, or uninterested in things you used to enjoy for more
than 2 weeks?" This screens for which diagnostic category?
A) Suicidality
B) Bipolar disorder
C) Major Depressive Disorder
D) Disruptive Mood Dysregulation Disorder
Correct Answer: C
Rationale: This question screens for Major Depressive Disorder (MDD). The key
criteria for a major depressive episode include depressed mood or anhedonia (loss
of interest/pleasure) lasting at least 2 weeks. While mood lability can be present in
, Bipolar Disorder, the specific inquiry about prolonged depressive symptoms aligns
most directly with MDD .
5. During the evaluation of a patient with a history of Bipolar I Disorder who is
manic, the patient states that she is actually the Queen of England and quite
wealthy. This is an example of which of the following?
A) Mood-congruent manic delusion
B) Mood-incongruent manic delusion
C) Mood-congruent manic hallucination
D) Mood-incongruent manic hallucination
Correct Answer: A
Rationale: A mood-congruent manic delusion aligns with the elevated or expansive
mood of mania. The belief of being royalty and wealthy reflects grandiosity, a
common symptom of manic episodes. Mood-incongruent delusions do not align
with the prevailing mood state and are less typical in mania .
6. A period of at least one week in which both a manic episode and a major
depressive episode occur almost daily is consistent with which diagnosis?
A) Bipolar II Disorder
B) Bipolar I Disorder, mixed episode
C) Bipolar I Disorder, cyclothymic type
D) Major Depressive Disorder with mixed features
Correct Answer: B
Rationale: A mixed episode in Bipolar I Disorder is characterized by criteria for
both a manic episode and a major depressive episode occurring nearly every day
for at least one week. This is distinguished from Bipolar II Disorder, which involves
hypomanic episodes rather than full manic episodes .
